Prognostic value of gasping for short and long outcomes during out-of-hospital cardiac arrest: an updated systematic review and meta-analysis

Abstract

ObjectiveWe systematically reviewed the literature to investigate whether gasping could predict short and long outcomes in patients with out of hospital cardiac arrest (OHCA).MethodsPubMed, Embase, and Cochrane Library were searched for observational studies regarding the prognostic effect of gasping on short and long outcomes in adults with OHCA. The primary outcome was return of spontaneous circulation (ROSC). The secondary outcomes were favorable neurological outcome at discharge or at 30 days after cardiac arrest;long term (≥6 months) survival; initial shockable rhythm.The Mantel-Haenszel method with random-effects model was used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs).ResultsFive studies (six cohorts) were included in the final analysis. In the pooled analysis, gasping was not only associated with a significant increase in ROSC (RR, 1.87; 95% CI, 1.64–2.13; I2 = 70%), but also a high likelihood of favorable neurological outcomes (RR, 3.79; 95% CI, 1.86–7.73), long-term survival (RR, 3.46; 95% CI, 1.70–7.07), and initial shockable rhythm (RR, 2.25; 95% CI, 2.05–2.48).ConclusionsCurrent evidence indicates that gasping can predict short and long outcomes in patients with OHCA.In addition, gasping is associated with a high likelihood of initial shockable rhythm,which may contribute to positive outcomes.

Agonal breathing upon hospital arrival as a prognostic factor in patients experiencing out-of-hospital cardiac arrest

“… 6 A systematic review investigated whether agonal breathing predicts short-term and long-term outcomes in OHCA. 7 The review, which included five studies, showed that agonal breathing was associated with a significant increase in the rate of return of spontaneous circulation (risk ratio [RR], 1.87; 95% CI, 1.64–2.13) and with a higher likelihood of favorable neurological outcomes (RR, 3.79; 95% CI, 1.86–7.73) and increased long-term survival (≥6 months) (RR, 3.46; 95% CI, 1.70–7.07) 6 , 16 , 17 , 18 . Debaty G. 2017 et al, reported that the combination of agonal breathing and appropriate initial shock waveform for electrical shock application had higher for favorable patient outcomes compared to no agonal breathing and no shockable rhythm.…”

“… 6 Previous studies in OHCA have reported that patients with agonal breathing have a 3.5 times higher survival rate than those without agonal breathing. 6 , 7 Additionally, in a study in which extracorporeal CPR (ECPR) was performed on patients who had agonal breathing during EMS transport, it served as a prognostic factor for improved outcomes. 8 However, this study did not examine patients with agonal breathing while on no ECPR during EMS Transport.…”

A survey on technologies used during Out of Hospital Cardiac Arrest

“…Agonal breathing can be a predictor of whether a patient is experiencing a cardiac arrest or not. If agonal breathing is detected, then there is a high probability that the initial rhythm of the patient is one that is conducive to defibrillation 71 . Researchers have found that in approximately 20-25% of the OHCA calls; cardiac arrest is not confirmed due to the uncertainty of the patient's breathing 65,58,59,72,4,69 .…”

“…As part of the assessment to determine whether an OHCA has occurred, the dispatchers must confirm the patient's responsiveness and their breathing pattern 63 . From these two medical signs, the caller can accurately determine the patient's responsiveness but may not accurately identify and describe the patient's breathing pattern to the dispatcher, causing delayed or incorrect assessment 58,71,72 . Many studies have been published that have analyzed the audio recordings from dispatch centers to determine the cause for delayed or missed diagnosis of cardiac arrest events 68,36,69 .…”

<p>Telephone CPR: Current Status, Challenges, and Future Perspectives</p>

“…24,25 Agonal respiration is an early sign of CA and studies indicate it is significantly associated with a high likelihood of initial shockable rhythm, which may contribute to good neurological outcomes. [25][26][27] Lay rescuers, however, usually do not consider this movement as a sign of CA and report that CA victims with agonal respiration are unconscious, but still breathing.…”